IRMP | International Graduates

A Complete Guide US Medical Residency for International Graduates

Looking to pursue Medical Residency in the USA? You’re not alone! According to the American medical association (AMA), about 22.7% of licensed physicians in the United States are International Medical Graduates (IMGs).

Many medical doctors and students worldwide choose to pursue Medical Residency in the USA due to its numerous benefits:

Quality of training
Research opportunities
Excellent career prospects post-training
Flexible employment system
High income and good lifestyle

But you don’t get something for anything. Or, in other words: No pain, no gain. The truth is, the US residency match is a highly competitive, challenging, and lengthy process.

Is it hard? The answer is yes. Is it worth it? The answer is still yes. Is it doable? The answer is definitely yes.

Therefore, If you’re willing to take on the challenge, we’ll review together in this article all you need to know about the US residency match journey.

Before taking action, you must first ensure that your medical school is listed in the World Directory of Medical Schools (World Directory) and, thus, that you’re eligible for the ECFMG certification.

If it’s not the case, you cannot start the ECFMG certification process and take any USMLE exams.

Obtain a USMLE/ECFMG Identification Number through ECGMG online services.
Submit the notarized Certification of Identification Form (Form 186) to ECFMG.

This part is quick and easy; you just have to follow the instructions.

Now that you’re registered, things will become more fun, as the next step involves much studying. A lot of studying.

You’ll have to take the USMLE Step 1 and the USMLE Step 2 CK exams to participate in the residency match. The exams are computer-based and shouldn’t be taken lightly, as they literally represent your application’s backbone. Luckily you can find on this website many articles related to USMLE Step preparation that will help you nail the exams. Before the Covid 19 pandemic, candidates had to clear the USMLE Step 2 CS exam to complete the ECFMG certification processes. This exam has been cancelled since and replaced for IMGs by Pathways to meet the clinical and communication skills requirements.

There are a total of 6 pathways, and the official website gives all the information to identify your pathway. Regardless of the pathway, you’ll have to take one final exam: The Occupational English Test.

Once you’re done with the USMLE exams and have cleared the pathway, to complete the ECFMG certification process, you must send your diploma and medical school credentials to ECFMG.

Processing these documents can take weeks to months, so you may have to be patient.

The residency match season usually starts in June every year. Once you are ECFMG certified, you must purchase a token that will give you access to your ERAS account.

Below is a "to-do" list to get you ready for the match program:

1. Work on a list of programs you want to apply to.
2. Start writing your personal statement.
3. Collect the Letters Of Recommendation from the doctors you’ve worked with.
4. Work on your resume.
5. Gather all the necessary documents.

We have detailed what is “officially” requested to participate in the match process and be considered by most programs. But participating doesn’t necessarily mean matching.

To match, you must be considered a “strong candidate,” which takes much more than we’ve just seen.

Scores

Scores are critical in the residency match journey.

Since USMLE Step 1 changed from a graded to a pass/fail exam, programs now place more emphasis on Step 2CK scores.

Although some residency programs specify a minimum passing score as a prerequisite for consideration, others do not. This does not necessarily imply that they place less importance on exam scores.

Usually, a score above 240 on Step 2CK is considered good. Of course, the greater your score is, the better it is for your application.

However, if you score below 240, you may still have further chances to match, as the minimum match score can vary depending on the specialty you are applying to. More details for each specialty are outlined in the NRMP charts.

For example, the average Step 2CK score to match into anesthesiology as an IMG in 2022 was 240, while it was 235 for internal medicine.

Research Experience and Publications

Having research or publications on your application is like adding sprinkles to your ice cream – it’s not necessary, but it makes it more enjoyable! That being said, the importance of research and publications can vary depending on the specialty you’re applying to, just like with Step 2CK scores. Competitive specialties like dermatology or neurosurgery tend to place a higher emphasis on research experience and publications, while less competitive specialties like family medicine or internal medicine may not stress them as much. If you want to learn more about getting publications, you can refer to this article that gives IMGs some clues on navigating the mysterious world of how to get published.

US Clinical Experience

US Clinical Experience (USCE) is the clinical experience International Medical Graduates (IMGs) acquire in the US healthcare system. Gaining clinical experience in the US is key for IMGs, as these experiences will allow you to:

Gain a better understanding of the US healthcare system and medical practices Enhance your clinical skills and build your confidence in patient care Demonstrate your ability to work in a US healthcare setting, which can improve your chances of matching into a US residency program. Make connexions that may boost your chances to match in a residency program. Get the Letters of recommendation you need to apply to programs. As with the scores, some residency programs detail how many and which type of USCE they require on their website, while others don’t.

This doesn’t mean that they don’t care, nor that those programs wouldn’t consider it.

Many IMGs wonder whether USCEs are mandatory because some programs mention in their requirement that IMGs can apply without USCEs.

Remember, applying doesn’t mean matching.

Therefore, can you apply to a program without any USCE? Yes.

However, is it a good idea to apply without any USCE? Definitively No.

If you’re an IMG with limited USCE, there are still ways to strengthen your application. Consider applying to clinical externships, observerships, or research positions in a US healthcare setting.

If you want more information about USCE, you can refer to my article about all you need to know about US Clinical Experience as an IMG.

Year of Graduation

First, what does Year Of Graduation (YOG) mean, and how do we calculate it?

Your year of graduation refers to the year you graduated from medical school and the time that has elapsed since then.

For example, if you graduated in March 2019 and plan on participating in the Match of September 2023, your YOG is four years and six months.

Does it matter?

Being an “old grad” is considered a red flag and may compromise your chances of matching in a US residency program. The definition of an old graduate can vary from program to program and can be anywhere from 2 to 5 years after graduation.

For the best chances of matching, it’s recommended to start the application process while still a student or within two years following graduation.

However, even if you graduated 5 or 10 years ago, don’t lose hope. Some programs do accept IMGs who graduated more than five years ago. The more recently you’ve graduated, the better your chances are to match, so staying up to date with the requirements and timelines for each program is essential.

By keeping your options open and being proactive in your application process, you can increase your chances of success and find the best program to fit your needs.

Visa Status

If you are not a US citizen or a green card holder, you will need a visa to pursue residency training in the United States.

The most popular visas for IMGs are the J1 and H1B visas.

Understanding the differences between the J1 and H1B visas and their respective advantages and disadvantages is essential when pursuing residency in the US. By staying informed and prepared, you can make the best choice for your situation and achieve your goals in the US healthcare system.

Can international students take the USMLE

Yes, you can take the USMLE Step 1 and Step 2CK while still a medical student.

However, you must be graduated to take the USMLE Step 3.

Can foreign doctors work in the USA without taking the USMLE?

No, you cannot work as a doctor in the USA without first passing the USMLE.

How difficult are the USMLE exams for international students and graduates?

USMLE exams are challenging but doable, as you study for them seriously and consistently.

Do doctors get paid during medical residency in the USA?

Yes, you’ll get paid for your work once in a residency program.

Is there an age limit for taking the USMLE exams?

No, there is no age limit. However, your year of graduation counts regarding your chances to match in a residency program.

A Complete Guide US Medical Residency for International Graduates

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ECFMG Certification Process

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International Graduates

A Complete Guide US Medical Residency for International Graduates

ECFMG Certification

ECFMG Certification Process

Preparation

Match Process and Requirements

Frequently Asked Questions

Leave A Comment

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